{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:53:33Z","timestamp":1791579213201,"version":"4.3.4"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-traumatic hydrocephalus (PTH) is a common but dangerous complication of traumatic brain injury (TBI), increasing its morbidity\/mortality and complicating the outcomes. It may arise abruptly or appear later following injury, and it is sometimes linked to substantial ventriculomegaly. Its etiology is complex and multifactorial, including severe TBI, subarachnoid\/intracranial\/intraventricular hemorrhage, and decompressive craniectomy. However, the exact mechanisms of PTH development, including cerebrospinal fluid (CSF) disturbances, supported by neuroinflammation and subarachnoid obstruction, remain inadequately determined. Consequently, managing PTH patients is demanding and logistically challenging, involving detailed diagnostics, external or V-P shunting, regular follow-ups, and treatment of complications such as CSF leaks, shunt malfunctions, obstructions, over-drainage, and infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review aims to discuss and examine the mechanisms of PTH development in adults, predictors of its outcome\/progression, and the modalities and effectiveness of its surgical management. It is based on a comprehensive review of the relevant literature and a single-center retrospective analysis of a cohort of adult PTH patients over 1\u202fyear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PTH occurred in 20 (21.05%) out of a series of 95 patients who sustained a TBI for 1\u202fyear, due to CSF disturbance, triggering ventricular enlargement, and presenting with intracranial hypertension. Acute subdural hematoma was found in 14 (70.0%) patients, while midline shift\/cisternal compression was present in 13 (65.0%) patients. Both parameters were strongly correlated with increased ICP, which was associated with low admission Glasgow Coma Score (GCS), severe TBI, and an unfavorable outcome. Older age was also correlated with aSDH and severe TBI, and with a bad outcome when ICP was elevated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low admission GCS, aSDH, brain edema (midline shifting\/basal cisternal compression), elevated ICP, and older age are strong predictors of unfavorable outcome and considerably worse prognosis in TBI patients who develop PTH. It seems that only PTH patients with a syndrome of increased intracranial pressure (ICP) require unconditional surgery, while those with chronic symptoms may be observed for PTH progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1823124","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:46:35Z","timestamp":1782276395000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Post-traumatic hydrocephalus in adults: the mechanisms of development, predictors of progression and management strategies. A narrative review and case series analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Bruno","family":"Splavski","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Dubrovnik General Hospital","place":["Dubrovnik, Croatia"]},{"name":"University of Applied Health Sciences","place":["Zagreb, Croatia"]},{"name":"Department of Neurosurgery, University Hospital Center Sestre Milosrdnice","place":["Zagreb, Croatia"]},{"name":"European Academy of Sciences and Arts","place":["Salzburg, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Muzevic","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Osijek University Hospital Center","place":["Osijek, Croatia"]},{"name":"Faculty of Medicine, University of Osijek","place":["Osijek, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref1","first-page":"43","article-title":"Medical complications related to traumatic brain injury","volume":"3","author":"Bontke","year":"1989","journal-title":"Phys Med Rehabil: State Art Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"730","DOI":"10.3340\/jkns.2017.0210","article-title":"Factors associated with postoperative hydrocephalus in patients with traumatic acute subdural hemorrhage","volume":"60","author":"Kim","year":"2017","journal-title":"J Korean Neurosurg Soc"},{"key":"ref3","volume-title":"Rehabilitation of the Adult and Child with Traumatic Brain Injury","author":"Narayan","year":"1990"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3390\/medsci7030047","article-title":"Neurorehabilitation of traumatic brain injury (TBI): a clinical review","volume":"7","author":"Oberholzer","year":"2019","journal-title":"Med Sci (Basel)"},{"key":"ref5","first-page":"543","article-title":"Neurologic sequelae","volume":"4","author":"Stein","year":"1990","journal-title":"Phys Med Rehabil: State Art Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e1713","DOI":"10.1002\/hsr2.1713","article-title":"Posttraumatic hydrocephalus: recent advances and new therapeutic strategies","volume":"6","author":"Sanker","year":"2023","journal-title":"Health Sci Rep"},{"key":"ref7","volume-title":"Principles of Neurology","author":"Adams","year":"1989"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"267","DOI":"10.3109\/02699058809150897","article-title":"Incidence, CT findings and rehabilitation outcome of patients with communicative hydrocephalus following severe head injury","volume":"2","author":"Groswasser","year":"1988","journal-title":"Brain Inj"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1053\/s0003-9993(03)00314-9","article-title":"Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome","volume":"84","author":"Mazzini","year":"2003","journal-title":"Arch Phys Med Rehabil"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.3171\/2017.1.JNS162721","article-title":"Factors associated with shunt-dependent hydrocephalus after decompressive craniectomy for traumatic brain injury","volume":"128","author":"Vedantam","year":"2018","journal-title":"J Neurosurg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1590\/0004-282x20140106","article-title":"The influence of decompressive craniectomy on the development of hydrocephalus: a review","volume":"72","author":"Ding","year":"2014","journal-title":"Arq Neuropsiquiatr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/01616412.2000.11741034","article-title":"Post-traumatic hydrocephalus","volume":"22","author":"Guyot","year":"2000","journal-title":"Neurol Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/0387-7604(95)00070-r","article-title":"Classification of hydrocephalus and outcome of treatment","volume":"17","author":"Mori","year":"1995","journal-title":"Brain Dev"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1007\/s00701-022-05299-3","article-title":"Incidence of surgically treated post-traumatic hydrocephalus 6\u202fmonths following head injury in patients undergoing acute head computed tomography","volume":"164","author":"Heinonen","year":"2022","journal-title":"Acta Neurochir"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e491","DOI":"10.1016\/j.wneu.2024.02.060","article-title":"Incidence and risk model of post-traumatic hydrocephalus in patients with traumatic brain injury","volume":"185","author":"Pan","year":"2024","journal-title":"World Neurosurg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.3171\/jns.1996.85.6.1026","article-title":"Posttraumatic ventriculomegaly: hydrocephalus or atrophy? 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